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Speech, saliva and swallowing

Thick or sticky secretions

Saliva or mucus that has become thick and hard to shift, which is a different problem from too much thin saliva and is managed differently.

The clinical word for this is .

Still being checked

What this is

Thick secretions are about what the secretions are like rather than how much there is. They can come from being less well hydrated, from breathing through the mouth, or from medicines given to dry up saliva. Thick saliva in the mouth and thick mucus from the chest can feel like the same problem, but they are not the same thing, so it is worth asking your team which one applies to you.

What people often describe

  • Saliva that feels like glue, or strings that are hard to clear
  • Coughing that does not shift anything
  • A worse mouth first thing in the morning
  • Feeling that clearing your throat takes more effort than it used to

Important distinctions

  • The opposite problem, and the approaches pull against each other: medicines used for drooling work by drying. That is why the first thing NICE tells a team to do here is review those medicines rather than add something new.

  • Thick secretions are about what the secretions are like. How much force you have to move them is a separate question, and it is measured separately.

What may help

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Practical and self-management

Things people do themselves, or with whoever is helping them.

  • Keeping fluids up

    Keeping fluids up is one of the everyday measures teams suggest here, and one of the simplest to try.

    • Where swallowing has changed, how much and what to drink is worth working out with a speech pathologist or dietitian rather than on your own.

    Discuss with

    Compass explains

  • Humidifying the air

    Humidified air is used alongside breathing support, where the airflow itself can dry things out.

    Discuss with

    Compass explains

  • Positioning

    Sitting more upright is one of the everyday measures suggested for clearing secretions, as it is for drooling.

    Discuss with

    Compass explains

Allied health

What a therapist can assess, teach or adjust.

  • Airway clearance techniques

    Techniques that get more air behind a cough, taught by a physiotherapist. NICE names these as the first thing to try where a cough is not effective.

    Discuss with

    Compass explains

Medicines

Named here only where a guideline names them for this problem.

  • Reviewing the medicines you already take

    The first thing NICE tells a team to do for thick secretions is to look at the medicines already being taken, and it names treatments for drooling as the ones to look at. Those medicines work by drying saliva, which is why they are the first place a team looks when saliva has turned thick.

    Highlighted: shows the sources for this statement
    • This is not something to act on alone. Medicines are not started, stopped or changed without the clinician who prescribed them.

    Discuss with

    Compass explains

Equipment

Devices and physical aids.

  • Cough assist device

    A machine that pushes air in and pulls it out again. NICE positions it for when the simpler techniques are not enough, and during a chest infection.

    Discuss with

    Compass explains

  • Suction

    Clears what has already come up into the mouth. It does not reach the chest, so it sits alongside the clearance techniques rather than replacing them.

    Discuss with

    Compass explains

When to get this looked at sooner

Signs of a chest infection should not wait for your next contact. If you develop a fever, more phlegm, a cough that has changed, or you feel more breathless, see a doctor as soon as possible. A chest infection is one of the reversible causes of worsening breathing that guidelines tell teams to treat first, and it is harder to clear when secretions are already thick.

Highlighted: shows the sources for this statement

Who may help

Where Compass explains this

Questions

Cards

Other problems

Words explained

About this page

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Evidence for this page

The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.

  1. Statement 1 of 2. The first thing NICE tells a team to do for thick secretions is to look at the medicines already being taken, and it names treatments for drooling as the ones to look at. Those medicines work by drying saliva, which is why they are the first place a team looks when saliva has turned thick.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE puts reviewing current medicines first, ahead of adding anything, and names treatments for drooling as the ones to look at. Note the scope: the recommendation is written about thick saliva rather than about mucus from the chest.

      “If a person with MND has thick, tenacious saliva: review all current medicines, especially any treatments for sialorrhoea”

      1.8.15

      Link checked August 2026

  2. Statement 2 of 2. Signs of a chest infection should not wait for your next contact. If you develop a fever, more phlegm, a cough that has changed, or you feel more breathless, see a doctor as soon as possible. A chest infection is one of the reversible causes of worsening breathing that guidelines tell teams to treat first, and it is harder to clear when secretions are already thick.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      Republished from the Compass answer "When should I raise saliva problems with my team?", where this statement is already mapped to this source.

      “Treat people with MND and worsening respiratory impairment for reversible causes (for example, respiratory tract infections or secretion problems) before considering other treatments.”

      1.13.1

      Link checked August 2026